调查分析恶性血液病并发医院获得性肺炎的临床特点及影响因素

发布时间：2018-03-11 11:29

本文选题：血液病　切入点：恶性　出处：《宁夏医科大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的探讨恶性血液病并发医院获得性肺炎患者的临床表现，病原学特点，影响因素，治疗及预后，为临床防治提供依据。方法对宁夏医科大学总医院血液科2003年7月~2011年7月恶性血液病并发医院获得性肺炎住院患者资料进行回顾性分析。结果1.恶性血液病患者医院获得性肺炎的例次发生率为11.30%，以多发性骨髓瘤并发医院获得性肺炎最常见；老年人是感染的高发人群。2.多数患者有发热、咳嗽，半数表现为干咳；部分患者伴有畏寒、胸闷、气短及胸痛；病变大多为双侧，体征和影像学以渗出改变为主，实变征象相对少见；部分患者合并脓毒症，少数患者并发败血症、感染性休克及其它部位感染，病情凶险。3.痰培养结果中革兰氏阴性菌（G~-）占45.16%、革兰氏阳性菌（G~+）占29.03%、真菌占25.80%。4.易感因素与原发疾病类型，年龄，粒细胞水平，应用化疗、免疫抑制剂治疗及住院时间长短等有关。5.120例次恶性血液病并发医院获得性肺炎住院患者中，119例次经抗感染治疗，其中治愈66例次（55.46%），显效23例次（19.33%），进步16例次（13.45%），无效14例次（11.76%），治疗有效率为74.79%（89/119），似低于普通院内肺部感染治疗有效率。结论1.恶性血液病合并医院获得性肺炎发生率较高，严重威胁患者治疗及生存；2.患者大多由典型临床表现及影像学而诊断；部分患者缺乏典型临床表现，需依赖影像学早期诊断；少数患者易进展为脓毒症、败血症及感染性休克；3.革兰氏阴性菌(G-)感染居首位；4.其原发疾病类型，高龄，粒细胞减少，应用化疗、免疫抑制剂治疗，住院时间长是导致医院获得性肺炎的重要因素；5.恶性血液病并发医院获得性肺炎抗感染治疗难度大，需更注重抗菌药的合理使用。
[Abstract]:Objective to investigate the clinical manifestations, etiological characteristics, influencing factors, treatment and prognosis of patients with hematologic malignancy complicated with hospital acquired pneumonia, and to provide evidence for clinical prevention and treatment. Methods the data of hospitalized patients with nosocomial pneumonia from July 2003 to July 2011 in Hematology Department of Ningxia Medical University General Hospital were retrospectively analyzed. Results 1.The incidence of nosocomial pneumonia in patients with malignant hematologic diseases was 11.30, with multiple myeloma complicated with nosocomial pneumonia being the most common, the elderly being infected with high incidence of nosocomial pneumonia .2. most of the patients had fever, cough, and half of them had dry cough. Some of the patients were accompanied by chills, chest tightness, shortness of breath and chest pain; the lesions were mostly bilateral, the signs and imaging were mainly exudation, and the signs of solid changes were relatively rare; some patients were complicated with sepsis, and a few patients were complicated with sepsis. Infection of septic shock and other sites. 3. In the sputum culture results, Gram-negative bacteria (GC-) accounted for 45.16%, Gram-positive bacteria (G~) for 29.03um, fungi for 25.80.4.The susceptible factors and the types of primary diseases, age, granulocyte level, chemotherapy were used. The treatment of immunosuppressant and length of hospital stay were related to 5.120 cases of malignant hematologic diseases complicated with nosocomial pneumonia. 119 cases were treated with anti-infective therapy. Among them, 66 cases were cured with 55.46 times, 23 cases with remarkable effect and 19.33% with remarkable effect, 16 cases with progress of 13.45 times, 14 cases with no effect and 11.7660%. The effective rate of treatment was 74.79% 89 / 119, which seemed to be lower than the effective rate of treatment of pulmonary infection in general hospital. Conclusion 1. The incidence of nosocomial pneumonia in patients with hematologic malignancies is high, which is a serious threat to the treatment and survival of the patients. 2. Most of the patients are diagnosed by typical clinical manifestations and imaging, and some of the patients lack typical clinical manifestations. 2. A few patients are prone to develop sepsis, septicemia and septic shock. Gram-negative bacteria (G-G) infection is the first infection. 4. Its primary disease type, advanced age, granulocytopenia, chemotherapy, immunosuppressant therapy, Long hospital stay is an important factor leading to nosocomial pneumonia. It is difficult to treat nosocomial pneumonia with malignant hematologic diseases, so it is necessary to pay more attention to the rational use of antimicrobial agents.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R563.1

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